Evaluation of irradiated heart volumes in stage I breast cancer patients treated with postoperative adjuvant radiotherapy
Evaluation of irradiated heart volumes in stage I breast cancer patients treated with postoperative adjuvant radiotherapy
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DOI：
10.1200/jco.1997.15.4.1348
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发表时间：
1997-04-01
影响因子：
45.3
通讯作者：
Rutqvist, LE
中科院分区：
文献类型：
--
作者：
Gyenes, G;Gagliardi, G;Rutqvist, LE
目的：量化接受保乳手术治疗的左侧 I 期 (T1N0M0) 乳腺癌患者接受至少 25 Gy 切向光子场照射的心脏体积比例。方法和材料：回顾了 100 名连续患者的剂量计划。所有患者均接受仅覆盖左乳房的切向光子场照射。为每位患者制定了基于三维计算单应性 (CT) 的剂量计划。肿瘤的处方剂量为 50 Gy。对于每位患者，50% 等剂量中包含的心脏比例由累积剂量体积直方图 (DVH) 确定。在第一次斯德哥尔摩乳腺癌试验期间，对接受切向野治疗的左侧乳腺癌患者进行了相同的体积测定。结果：接受至少 25 Gy 的平均照射心脏体积为整个组的 5.7% (SD = 4.5%)，而在体积最高的组中为 11.9% (SD = 3.7%)。斯德哥尔摩试验中 50% 等剂量远端患者的平均受照射心脏体积为 25% (SD = 11.9%)。结论：在这项研究中，大多数左侧 T1N0M0 乳腺癌患者没有接受大量心脏体积的照射。然而，在所有研究的患者中，有 6% 的受照射心脏体积比例接近于斯德哥尔摩试验中使用的一种治疗技术对左侧肿瘤患者的受照射心脏体积。在之前的一项研究中，在长期随访评估中，该技术与心脏死亡率的显着增加有关。基于 CT 的三维治疗计划系统 (TMS) 是识别此类患者的宝贵工具；因此，可以采取适当的治疗来减少受照射的心脏体积。 (C) 1997 年，美国临床肿瘤学会。
Purpose: To quantify the proportion of heart volumes that received at least 25 Gy with tangential photon fields in patients with left-sided stage I (T1N0M0) breast cancer treated with breast-conserving surgery.Methods and Materials: The dose planning of 100 consecutive patients was reviewed. All were irradiated with tangential photon fields that covered the left breast only. A three-dimensional computed homographic (CT)-based dose planning was made for each patient. The prescribed dose to the tumor was 50 Gy. For each patient, the proportion of the heart included in the 50% isodose was determined from the cumulative dose-volume histogram (DVH). The same volume determination was made for the left-sided breast cancer patients treated with tangential fields during the first Stockholm Breast Cancer Trial.Results: The mean irradiated heart volume that received at least 25 Gy was 5.7% (SD = 4.5%) far the whole group and 11.9% (SD = 3.7%) in those with the highest volumes. The mean irradiated heart volume included in the 50% isodose far patients in the Stockholm Trial was 25% (SD = 11.9%).Conclusion: In this study, the majority of patients with left-sided T1N0M0 breast cancer did not receive irradiation to substantial heart volumes. However, in 6% of all studied patients, the proportion of irradiated heart volume was close to the irradiated heart volumes with one of the treatment techniques used in the Stockholm Trial far patients with left-sided tumors. That technique has been associated with significantly increased cardiac mortality during long-term follow-up evaluation in a previous study. The CT-based three-dimensional treatment planning system (TMS) represents a valuable tool in identifying such patients; thus, treatment may be conformed to reduce the irradiated heart volume. (C) 1997 by American Society of Clinical Oncology.